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Burdett County 1410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> y O <br /> H <br /> C <br /> OWNER �r fry P r,r��SD� TELEPHONE m <br /> HOME ADDRESS ��c, bv��P 1S r� v 0�p <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER �Qg �D ROAD NAME <br /> a <br /> 1 . <br /> LEGAL DESCRIPTION(see tax receipt) 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE ADDITION El PRI0 <br /> TYPE OF PERMIT(S): ' Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ` N: <br /> STRUCTURE/ADDITION USE: 6Znra 9C., Jt <br /> [/'(Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> Co-BUILDING CONTRACTOR: f�/�� NJ/7f " Sk— 3 to 6 X 6•, <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS,LAKE, LOT LINES. r <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2, <br /> MUST BE SIGNED AND DATED BY THE OWNER. f'o O O <br /> o � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. 2 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i©Q <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Ol <br /> 4. NORSTRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE4� A i€R Sr <br /> SETBACK AREA. <br /> r <br /> s.N� This structure to be used as private residential �� x v 0 r o o -0 <br /> CD m m m m <br /> garage/storage only. Not to be used for human �,� a x a rn <br /> 6. <br /> V N tll �'_. <br /> habitation. A Y J N N 7 9 3 <br /> 7. g, _ o€ <br /> your Z <br /> _ cn m <br /> PP (including Yaccompanying ) y \ — q ' P ' <br /> I declare that this application Includin an schedule has been examined he be t of'm o C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible I uracy of [� n <br /> all information contained in this application(including any accompanying schedule)and I further re that recognize �\ m m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 00 O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am �' m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have Vcess to the abMe descr' ed premises at any rea onable time for the purpose of inspection. -n <br /> CD <br /> cr <br /> SIGN HERE <br /> (signatua of ow r or building contract (date) <br /> ZONING ADMINISTRATOR <br /> t4r, N N [A N <br /> A O N nnpTOW SHIP PERMITS MAY BE REQUIRED � o000 0000 <br />